Insulin

Medicare Part B (Medical Insurance) doesn’t cover these:

  • Insulin (unless use of an insulin pump is  medically necessary
  • Insulin pens
  • Syringes
  • Needles
  • Alcohol swabs
  • Gauze

Part D  covers these:

  • Injectable insulin that isn’t used with a traditional insulin pump
  • Insulin used with a disposable insulin pump
  • Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs

Your costs in Original Medicare

The cost of a one-month supply of each Part D-covered insulin is capped at $35, and you don’t have to pay a deductible for insulin. This applies to everyone who takes insulin, even if you get Extra Help. If you get a 60- or 90-day supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin. For example, if you get a 60-day supply of a Part D-covered insulin, you'll generally pay no more than $70.  Other questions about insulin coverage?

Plans have until the end of March 2023 to update their systems to reflect the $35 cap on insulin, which means you might be charged a higher amount during this time when you fill a prescription for insulin. If you you pay more than $35 for a month’s supply of a covered insulin product in January and/or February 2023, your plan must reimburse you within 30 calendar days for any amount you paid above the $35 cap. Contact your plan to find out how to get reimbursed.

If you take insulin, you should get help comparing Medicare drug plans and costs for 2023:

What if I want to change plans?
If you use a covered insulin product you can add, drop, or change your Part D coverage one time between now and December 31, 2023. If you change plans mid-year, your True Out-of-Pocket (TrOOP) costs will carry over from one plan to the next. Call 1-800-MEDICARE if you take insulin and want to change your plan.

Note: Starting July 1, 2023 similar caps on costs will apply for insulin used in traditional insulin pumps (covered under Medicare Part B).

For insulin used with a traditional insulin pump that's covered under the Medicare durable medical equipment benefit, you pay 20% of the  Medicare-Approved Amount  after you meet the Part B deductible. You pay 100% for insulin-related supplies (like syringes, needles, alcohol swabs, and gauze), unless you have Part D.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • If your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Things to know

If you use an external insulin pump that isn’t disposable, Part B may cover insulin used with the pump and cover the pump itself as durable medical equipment (DME). If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to pay for a durable insulin pump.